Provider Demographics
NPI:1497343867
Name:KINCHELOE, LACEY (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:LACEY
Middle Name:
Last Name:KINCHELOE
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 BILL KENNEDY WAY SE APT A-135
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30316-7214
Mailing Address - Country:US
Mailing Address - Phone:404-272-4408
Mailing Address - Fax:401-652-0181
Practice Address - Street 1:1035 LOWER FAYETTEVILLE RD
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-1132
Practice Address - Country:US
Practice Address - Phone:404-272-4408
Practice Address - Fax:401-652-0181
Is Sole Proprietor?:No
Enumeration Date:2021-01-01
Last Update Date:2021-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH029185183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist